What tools can we use to understand and shift behaviors for better development?  

Surgo’s CUE Framework for Behavior Change

Development dollars don’t always have the maximum impact. A key contributing reason is that programs are not always based on a deep and nuanced understanding of what drives behavior. Whether the goal is to ensure that pregnant women attend antenatal check-ups, that teachers follow best-practice guidelines in the classroom, or that farmers switch to drought-resistant crops, changing people’s behavior is likely to be part of a well-designed program. This requires analysis of the many root causes of behavior, a toolkit of tailored interventions to address those factors, and methods to rapidly test and evaluate the interventions.

Until now, there has been no comprehensive framework connecting all these components of the behavior change process. To fill this gap, Surgo Foundation has developed the CUE Framework for Behavior Change. CUE stands for Change through Understanding and Evaluation: to change behavior, one must first understand what drives it, and then evaluate interventions to optimize their effectiveness.

The framework offers a clear approach and tools for addressing behavior change – it systematizes how to identify the root causes of behavior, accounts for differences among people, and makes designing and evaluating interventions more efficient and effective. CUE is designed to be adaptable to any program. Our goal is to make it a resource freely available to donors, governments, researchers, and program implementers around the world.

CUE is a five-part framework, with supporting tools, that can be applied in sequence to systematically assess and map behaviors of interest and the people involved in them, identify the specific drivers of behavior and any gaps in the evidence, measure differences within populations, and then design and evaluate interventions for behavior change.



Part 1: Framing

  1. Map the institutions/systems and people involved in behavior, prioritize people to target
  2. Match existing evidence to internal and contextual drivers of behavior
  3. Identify evidence gaps to be filled by additional research

Part 2: Measure Drivers

  1. Drive research to close evidence gaps, matching suitable methods to drivers being studied

Part 3: Measure Heterogeneity

  1. 'Segement' people on the differences in what drives their behavior
  2. Prioritize which segments to target with interventions

Part 4: Design Interventions

  1. Identify interventions to address the gaps between actual and target behavior
  2. Prototype interventions

Part 5: Evaluate and Optimize

  1. Choose method to evaluate interventions, simulated or field-based


An important feature of CUE is its focus on understanding and addressing the comprehensive set of internal and contextual drivers that shape behavior, compiled from the best evidence across the behavioral sciences. Rather than using a one-size-fits-all approach, it also helps programs see how those drivers vary among people.

Surgo is developing best-practice guidance documents and videos for the CUE framework, springing from our ongoing work in behavior-change research, as well as multidisciplinary resource lists offering expertise from academia and the private sector. We are also creating a set of tools to enable users to map the interactions of people and systems, match data and behavioral drivers to the most suitable type of intervention, and prioritize potential interventions to suit program goals.

We are already using the CUE approach in our work in India on improving maternal and neonatal health and reducing tuberculosis. For example, we are identifying the drivers of poor clinical practices by staff nurses that affect neonatal mortality, and designing research to quantify these findings, so that interventions can be designed to improve nursing practice.

As we demonstrate the efficiency of the CUE approach, we aim to respond to the demand for it within the development sector and stimulate further interest. We will help connect those who adopt the framework with experts who can help them implement its innovative features. Together, the CUE Framework for Behavior Change and its compendium of cross-disciplinary methods and tools provide a unique resource to guide programs toward behavior change that is as efficient as it is effective.